1
|
Fisher RS, Acharya JN, Baumer FM, French JA, Parisi P, Solodar JH, Szaflarski JP, Thio LL, Tolchin B, Wilkins AJ, Kasteleijn-Nolst Trenité D. Visually sensitive seizures: An updated review by the Epilepsy Foundation. Epilepsia 2022; 63:739-768. [PMID: 35132632 DOI: 10.1111/epi.17175] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 12/19/2022]
Abstract
Light flashes, patterns, or color changes can provoke seizures in up to 1 in 4000 persons. Prevalence may be higher because of selection bias. The Epilepsy Foundation reviewed light-induced seizures in 2005. Since then, images on social media, virtual reality, three-dimensional (3D) movies, and the Internet have proliferated. Hundreds of studies have explored the mechanisms and presentations of photosensitive seizures, justifying an updated review. This literature summary derives from a nonsystematic literature review via PubMed using the terms "photosensitive" and "epilepsy." The photoparoxysmal response (PPR) is an electroencephalography (EEG) phenomenon, and photosensitive seizures (PS) are seizures provoked by visual stimulation. Photosensitivity is more common in the young and in specific forms of generalized epilepsy. PS can coexist with spontaneous seizures. PS are hereditable and linked to recently identified genes. Brain imaging usually is normal, but special studies imaging white matter tracts demonstrate abnormal connectivity. Occipital cortex and connected regions are hyperexcitable in subjects with light-provoked seizures. Mechanisms remain unclear. Video games, social media clips, occasional movies, and natural stimuli can provoke PS. Virtual reality and 3D images so far appear benign unless they contain specific provocative content, for example, flashes. Images with flashes brighter than 20 candelas/m2 at 3-60 (particularly 15-20) Hz occupying at least 10 to 25% of the visual field are a risk, as are red color flashes or oscillating stripes. Equipment to assay for these characteristics is probably underutilized. Prevention of seizures includes avoiding provocative stimuli, covering one eye, wearing dark glasses, sitting at least two meters from screens, reducing contrast, and taking certain antiseizure drugs. Measurement of PPR suppression in a photosensitivity model can screen putative antiseizure drugs. Some countries regulate media to reduce risk. Visually-induced seizures remain significant public health hazards so they warrant ongoing scientific and regulatory efforts and public education.
Collapse
Affiliation(s)
- Robert S Fisher
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jayant N Acharya
- Department of Neurology, Penn State Health, Hershey, Pennsylvania, USA
| | - Fiona Mitchell Baumer
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
| | - Jacqueline A French
- NYU Comprehensive Epilepsy Center, Epilepsy Foundation, New York, New York, USA
| | - Pasquale Parisi
- Department of Neuroscience, Mental Health, and Sensory Organs, Sapienza University, Rome, Italy
| | - Jessica H Solodar
- American Medical Writers Association-New England Chapter, Boston, Massachusetts, USA
| | - Jerzy P Szaflarski
- Department of Neurology, Neurobiology and Neurosurgery, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA
| | - Liu Lin Thio
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Benjamin Tolchin
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | | |
Collapse
|
2
|
Meritam Larsen P, Wüstenhagen S, Terney D, Gardella E, Alving J, Aurlien H, Beniczky S. Photoparoxysmal response and its characteristics in a large EEG database using the SCORE system. Clin Neurophysiol 2021; 132:365-371. [PMID: 33450559 DOI: 10.1016/j.clinph.2020.10.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/20/2020] [Accepted: 10/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize photoparoxysmal EEG response (PPR) using a standardized protocol of intermittent photic stimulation (IPS) and standardized definitions for PPR, classified into six types. METHODS Using the SCORE system (Standardized Computer-Based Organized Reporting of EEG) we prospectively built a large database of standardized EEG annotations. In this study, we extracted the features related to PPR from the structured dataset consisting of 10,671 EEG recordings with IPS, from 7,188 patients. RESULTS The standardized IPS protocol elicited PPR in 375 recordings (3.5%), in 288 patients (4%), with a preponderance among young (11-20 years) and female patients (67%). PPR was persistent in patients with multiple recordings. The most frequent type of PPR was activation of preexisting epileptogenic area (58%), followed by generalized-PPR limited to the stimulus train (22%). We could not find any recording with self-sustained posterior response. Seizures were elicited in 27% of patients with PPR, most often myoclonic seizures and absences, in patients with self-sustained generalized PPR. CONCLUSIONS The most common type of PPR was accentuation of preexisting epileptogenic area. Self-sustained posterior response could not be documented. Self-sustained generalized-PPR had the highest association with seizures. SIGNIFICANCE Using standardized stimulation protocol and definitions for PPR types, IPS provides high diagnostic yield.
Collapse
Affiliation(s)
- Pirgit Meritam Larsen
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare)
| | - Stephan Wüstenhagen
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare)
| | - Daniella Terney
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare)
| | - Elena Gardella
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare); University of Southern Denmark, Denmark
| | - Jørgen Alving
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare)
| | - Harald Aurlien
- Section for Clinical Neurophysiology, Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Sándor Beniczky
- Department of Clinical Neurophysiology, Danish Epilepsy Centre, Dianalund, Denmark (member of the European Reference Network EpiCare); Department of Clinical Neurophysiology, Aarhus University Hospital, and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| |
Collapse
|
3
|
Skadorwa T, Strzelecka J. Patterns of intrahemispheric propagation in pediatric photoparoxysmal response. Seizure 2017; 51:107-113. [DOI: 10.1016/j.seizure.2017.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 01/03/2023] Open
|
4
|
Brauer C, Kästner SBR, Kulka AM, Tipold A. Activation procedures in the electroencephalograms of healthy and epileptic cats under propofol anaesthesia. Vet Rec 2012; 170:360. [DOI: 10.1136/vr.100113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- C. Brauer
- Department of Small Animal Medicine and Surgery; University of Veterinary Medicine Hannover; Germany, Bünteweg 9, D - 30559 Hannover Germany
| | - S. B. R. Kästner
- Department of Small Animal Medicine and Surgery; University of Veterinary Medicine Hannover; Germany, Bünteweg 9, D - 30559 Hannover Germany
| | - A. M. Kulka
- Department of Small Animal Medicine and Surgery; University of Veterinary Medicine Hannover; Germany, Bünteweg 9, D - 30559 Hannover Germany
| | - A. Tipold
- Department of Small Animal Medicine and Surgery; University of Veterinary Medicine Hannover; Germany, Bünteweg 9, D - 30559 Hannover Germany
| |
Collapse
|
5
|
Fallah A, RamachandranNair R. Does photoparoxysmal response in children represent provoked seizure? Evidence from simultaneous motor task during EEG. Clin Neurol Neurosurg 2008; 111:147-50. [PMID: 18977586 DOI: 10.1016/j.clineuro.2008.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 09/04/2008] [Accepted: 09/05/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Acute cognitive changes during epileptiform discharges have been studied using computer assisted cognitive tasks. We aimed to demonstrate acute behavioral change (using a simple motor response task MRT) during photoparoxysmal response (PPR) in children below 18 years. METHODS Children performed a simple repetitive motor task during intermittent photic stimulation (IPS). All episodes of PPR not associated with obvious clinical change (as observed by the technologist or reported by the patient) were analyzed for this study. The average time interval between two successive motor responses across a PPR (test time) was compared to the average time interval between two successive motor responses during IPS not associated with PPR (control time) using Wilcoxon signed ranks test. RESULTS 21 children who had PPR successfully completed the MRT. The difference between the mean durations was 0.894 s (p=0.002). More than 50% increase compared to the control time was considered a delay in MRT during PPR. 10 children showed slowing of MRT during PPR. CONCLUSION By definition, acute behavioral change during generalized epileptiform discharges represent provoked seizures. Detecting subclinical seizures can have important safety implications in children (skiing, skating and driving) with PPR on EEG, but no clinical seizures. We recommend MRT during IPS.
Collapse
Affiliation(s)
- Aria Fallah
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | | |
Collapse
|
6
|
Abstract
Photic stimulation is part of a typical EEG in most countries, especially to check on the photoparoxysmal response (PPR). Interest in this response was enhanced in 1997 when hundreds of Japanese children had attacks while viewing a TV cartoon called "Pokemon." The overall prevalence of the PPR among patients requiring an EEG is approximately 0.8%, but 1.7% in children and 8.87% in patients with epilepsy, more often in Caucasians and females. Autosomal dominant inheritance is indicated, and this response is seen especially at the wavelength of 700 nm or at the flicker frequency of 15-18 Hz. The PPR extending beyond the stimulus carries no increased risk of seizures. Prognosis is generally good, especially after 20 years of age. Attention to PPR has been increased with the advent of video games, and the evoked seizures from these games are likely a manifestation of photosensitive epilepsy. Drug therapy has emphasized valproic acid, but Levetiracetam has also been successful in eliminating the PPR.
Collapse
Affiliation(s)
- John R Hughes
- Department of Neurology, University of Illinois, Medical Center at Chicago, Illinois 60612, USA.
| |
Collapse
|
7
|
Abstract
The EEG is the most common neurodiagnostic test performed to evaluate patients with suspected seizures. The majority of EEGs are requested in patients because of suspected seizures or for seizure management. It is unlikely that the patient's usual spell will be recorded during a routine EEG. Therefore, several activation techniques have been used in clinical EEG to help increase the occurrence of interictal epileptiform abnormalities, which are highly correlated with the diagnosis of a seizure disorder. EEG laboratories have long employed these techniques, which include hyperventilation, intermittent photic stimulation, sleep, and sleep deprivation. However, despite being utilized in routine clinical EEGs for decades, a number of differing views on the usefulness and indications for these procedures exist. This review will evaluate these procedures and review their history, technique, effectiveness, controversies, and unanswered questions.
Collapse
Affiliation(s)
- Oscar E Mendez
- Department of Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | |
Collapse
|